Individual
MICHELLE ELAINE BLACKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
028145
IL
363L00000X
Nurse Practitioner
SP028660
PA
363LF0000X
Family Nurse Practitioner
028145
IL
363LN0000X
Neonatal Nurse Practitioner
11733
TN
363LN0000X
Neonatal Nurse Practitioner
Primary
217686
OK
363LN0000X
Neonatal Nurse Practitioner
225161
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
620476822
VMG TAX ID
TN
Enumeration date
07/27/2006
Last updated
01/28/2025
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